Who is at high risk of CHD?
Risk of coronary heart disease increases with the number of risk factors an individual has. Old age, genetics and being male increase the risk but the lifestyle influenced factors are:
- raised blood cholesterol
- high blood pressure
- poor nutrition
- smoking
- obesity
- physical inactivity
- diabetes
The risk of coronary heart disease rises with every unit increase in blood pressure and blood cholesterol concentration above the biological ideal. This means that the majority of coronary heart disease events (80%) occur in individuals who are not targeted in the current prevention strategy.
Both blood pressure and blood cholesterol in the UK population increase with an individual's age, and these are also more prevalent among men than among women. It is these two irreversible risk factors of age and sex that best predict an individual's risk of coronary heart disease, alongside a history of previous cardiovascular disease.
Targeting those at 'high risk' is a way of rationing scarce resources. The number of people of state pensionable age (age 65 or above for men, age 60 or above for women) is projected to increase from 10.9 million in 2002 to 12.2 million in 2011. CHD and the scarcity of medical and financial resources to treat it will increase. This is why prevention has moved centre stage.
A government strategy targeting prevention efforts on the basis of age could absorb almost the entire NHS budget. It may also be unacceptable to the public. A population-wide approach may prove more effective.
The need for a population-wide approach
National Heart Forum believes that the focus of prevention activity on individuals at 'high risk' has been at the expense of efforts to prevent the burden of disease by nurturing healthier lifestyles among the whole population.
The distribution of risk factors for coronary heart disease in the UK, and their increase with increasing age, is as a result of the Western 'average' lifestyle.
It has been shown possible through healthy lifestyle alone, to retain low physiological measurements throughout the lifetime (i.e. with no increase of the variables with age).
Origins in childhood
There is evidence that coronary heart disease has its origins in childhood. Atherosclerosis, the product of raised blood pressure and high cholesterol levels, may be present in one in three 20 year olds.
The challenge for the UK therefore is to develop and successfully implement a public health strategy that brings about a cultural change towards healthier lifestyles, beginning in childhood and maintained throughout life.
Public health policy, lifestyle and culture change
Historically, great public health successes have involved mass changes in the environment and in nutrition through regulation or supply by public authorities. However, a cultural change towards healthy lifestyles cannot simply be supplied to a passive public.
A Treasury-commissioned review recommended that there should be greater public spending on the provision of information to the public and on ensuring choice for all. Only in this way could the government expect to nurture a population that was more engaged in protecting its own health, enjoying healthier lifestyles and reducing their risk of preventable disease.